Consequências metabólicas na SAOS não tratada

Abstract

There is a recognized association between obstructive sleep apnea syndrome and metabolic syndrome, designated syndrome Z. The criteria for metabolic syndrome include at least three of the following factors: central obesity (waist circumference ≥ 102 cm for males and ≥ 88 cm for females); triglycerides ≥ 150 mg/dL; HDL cholesterol < 40 mg/dL for males and < 50 mg/dL for females; arterial blood pressure ≥ 130/85 mmHg; and fasting glucose ≥ 100 mg/dL. Central obesity is associated with OSAS and metabolic syndrome, and there is evidence that obstructive sleep apnea is an independent risk factor for obesity, glucose intolerance and insulin resistance. The implied mechanisms result from the activation of the sympathetic nervous system and of the hypothalamus-hypophysis-adrenal axis; activation of pro-inflammatory markers, such as IL-6 and TNF-α; and the reduction in adiponectin levels, principally triggered by intermittent hypoxemia related to apnea. Despite such evidence, the results are controversial regarding the benefits of treating sleep apnea with CPAP in the presence of these metabolic alterations. In addition, the few studies that have addressed sleep apnea as a risk factor for dyslipidemia have presented conflicting results. Population-based, longitudinal controlled studies are necessary in order to elucidate the interaction between sleep apnea and metabolic consequences so that these individuals are properly treated.

Jejum inferior a oito horas em cirurgias de urgência e emergência versus complicações

“…As possible interest variables, we also evaluated the need for postoperative blood transfusion, surgical site infection diagnozed during hospitalization, and death during hospitalization. These outcomes were selected by their relationship with the presence of food in the gastrointestinal tract and/or for appearing in studies concerning this theme (2,8,10,14) .…”

“…Therefore, fasting generates anxiety and discomfort to patients and may be related to metabolic complications, such as the emergence of insulin resistance (IR) associated with postoperative hyperglycemia by decreasing the availability of insulin to the peripheral tissues and difficulty of glucose uptake. This process occurs, mainly, in the early days after surgery and is caused by various physiological factors linked to prolonged preoperative fasting and reduction of carbohydrate intake, negatively affecting the results of surgical recovery, increasing risk of infections and slowing cicatrization (1)(2)(6)(7)(8)(9) .…”

“…The supply of fluids to the patient preoperatively brings improvement in well-being and physiological functions, reducing insulin resistance, hunger and thirst before surgery, reflecting positively in the postoperative period, with the decrease in recovery time after surgery, rapid return of intestinal functions, better glycemic control, decrease of surgical site infections and postoperative morbidity and mortality rates, and consequently of the length of hospitalization (2,8,10,14) .…”

Estressores ocupacionais, concentração do cortisol e saúde de motoristas de caminhão

“…Tanto os transtornos mentais, quanto a SAOS podem ter efeitos nas concentrações de cortisol (PRUESSNER et al, 2003, LINDSTRON, 2006, CARNEIRO et al 2010, JESUS et al 2010. No presente estudo, foi analisada a correlação entre o escore do questionário de DPM e o cortisol, porém não houve significância nessa correlação.…”

“…Tais resultados corroboram a literatura, pois a apnéia do sono per si é um fator de risco para a hipertensão arterial (JESUS et al, 2010) e dislipdemias, independente do peso corporal e obesidade central (CARNEIRO et al, 2010). Sugere-se que a ativação do sistema nervoso simpático e do eixo hipotálamo-ptuitária-adrenal, (com aumento da concentração do cortisol) esteja relacionada nesse mecanismo (CARNEIRO et al 2010, JESUS et al 2010.…”